Prediction of the fact and degree of coronary artery disease using the processing of clinical and instrumental data by artificial intelligence

Aim of the study was to analyze the possibility of using neural network analysis to predict the severity of coronary bed lesion. The study was also designated to determine the performance and accuracy of the trained neural network model receiving input as the structured data and EGG images with the parameters and leads positioning differ from the training sample, and also to compare the efficiency of detecting transient myocardial ischemia with traditional diagnostic methods, such as 24-hour Holter monitoring, treadmill test. Neural network analysis of the available clinical, laboratory and instrumentation data allow to configure the network parameters for further prediction of coronary artery disease. The results obtained in the form of an AUC score allow to consider this method to be effective in the coronary artery disease diagnosis using recorded ECG tape with parameters and lead positioning differ from initial training sample. The efficiency of transient myocardial ischemia detection on the training sample of the trained neural network is higher in comparison with traditional diagnostic methods, such as 24-hour Holter monitoring, treadmill test.

Mechanism of antisurdant action of triazin-indole derivative at experimental acoustic trauma

In our research performed using model of acoustic trauma at experimental animals (female of hybrids F1 of CBA and C57BL/6 lines) influence of triazin-indole at expression level of hypoxia induced factor (HIF) in Corti’s organ was studied at its therapy application. As a reference drug cytoflavin was used. Investigated drug in the form of 1 % solution was introduced into animals parenterally in dosage 5, 7, 10 mg/kg with 2 hr intervals after acoustic impact. Injection of cytoflavin as reference drag was performed in 1.7 ml/kg dosage. Level of HIF expression in the drug of Corti’s organ was estimated using immunohistochemical method. It was found out that triazin-indole derivative increases HIF expression in Corti’s cells and in neurons of spiral ganglion at acoustical traumatic impact depending on drug dosage increase. Maximal HIF expression in Corti’s cells and in ganglions were noted at therapeutic dose of the drug 10 mg/kg. In control group and in the group with application citoflavin in dose 1.7 ml/kg minimal HIF expression was observed. According to obtained results of performed investigation the authors concluded that antisurdant property of triazin-indole derivative is realized through the influence on HIF metabolism (probably, by blockage of prolyl hydroxylase) and enables to consider it as a target molecular during the drug application.

Nutritional stereotypes of children with insulin-dependent diabetes mellitus

In most cases, type 1 diabetes mellitus is an autoimmune disease characterized by the destruction of insulin-producing beta cells, which is the result of absolute insulin deficiency and, therefore, treatment is associated with the administration of insulin. The therapeutic treatment of type 1 diabetes includes the use of insulin for glycemic control, balanced nutrition and regular physical activity. Daily insulin requirements vary depending on age, diet, self-monitoring of blood glucose and daily routine. Obesity affects some patients with type 1 diabetes, which increases their insulin requirements and negatively affects their metabolic control. The type 1 diabetes diet is an essential part of the treatment program and helps to achieve glycemia targets and avoid insulin dose difficulties. Traditionally, for sick children and their parents, there are diet classes in the School of diabetes, but the equivalence in terms of diet and the actual nutrition of children is not sufficiently studied. Therefore, a combination of insulin therapy and an individual nutrition plan is necessary, which is the key to proper metabolic control. The usual nutritional guidelines for patients with type 1 diabetes should be the same as those for the general population.

To the question of the history of the formation and development of orthopedic dental care in Russia

The article is devoted to the formation and development of orthopedic dental care in Russia.The focus is on the analysis of the organizational aspects of the provision of orthopedic care in general, the study of the processes of the emergence and formation of medical and social programs in terms of the provision of orthopedic dental care. The beginning of the article is connected with the background and history of the development of orthopedic dental care in Russia. The emergence of the term “medical and social care” in general and in dentistry in particular refers to the Soviet post-revolutionary period of national history. The authors analyze aspects of the history of the formation and development of medical and social programs for certain segments of the population, consider the quality and accessibility of orthopedic dental care created in the Soviet health care system, the specifics of development and legal regulation of the industry in the Soviet period. According to the authors, in the entire history of domestic health care, mass free and generally accessible provision of complex and currently quite expensive dental orthopedic care was implemented for the first time in the world in the Soviet Union for the insured population of the country. However, the level of training of specialists, the quality of materials, tools and manufactured prostheses remained low. The population of the country did not impose high aesthetic and functional requirements for the dentures and it also contributed to their low quality.

Epidemiological and clinical features of the course of postoperative sternomediastinitis (clinical case)

Health-care-related infections are becoming more relevant today. The difficulty and largely of diagnosis increased impact of adverse effects (postoperative period, increase of bed-days, use of irrational antibacterial therapy, use of excessive methods of disinfection) factors of the hospital environment on the human body, contributing to the development of severe postoperative complications, among them, sternomediastinitis occupies a special place in cardiac surgery. The clinical case we represent clearly demonstrates the atypical flow of sternominetite caused by the hypervirulent strain Klebsiella pneumoniae blaNDM-Type. Generally, sternomediastinitis causes Staphylococcus epidermidis, Staphylococcus haemolyticus. Every week the patient stays in the cardiothoracic ward of the hospital is associated with a 15 % increase in the risk of mediastinitis development. The data indicate the need for continuous epidemiological monitoring of the relevant microorganisms that are potential agents of nosocomial infections. Thus, adequate diagnosis, choice of rational treatment tactics and effective antibacterial therapy significantly improve the prognosis of the current of a given severe disease. Early epidemiological diagnosis will help to reduce the risk of the development and spread of hospital-acquired infections in the post-operative period.

New possibilities of screening for mental disorders in cardiology practice

Aim of the study: validation of novel algorithm for screening of mental comorbidity in general medical practice. Based on retrospectively formed registry of patients, we assessed an effectiveness of the previously proposed Psycho-cardiac comorbidity Index. An external validation was provided, with subgroup analysis on cohort of patients who presented with suspected “Non-ST-elevation acute coronary syndrome” (N = 577), with assessment of psychopharmacotherapy prescription rate and prevalence of anxiety and depression. Another validation was carried out via comparison with patients with verified mental disorders (N = 235). A positive association was found between magnitude of Psycho-cardiac comorbidity index and Hospital anxiety and depression subscales (r = 0.26, p < 0.001 for anxiety subscale, r = 0.17, p = 0.026 for depression subscale), over-diagnosis of acute coronary syndrome at pre-hospital stage (r = –0.27, p < 0.0001), as well as with neurotic, affective and somatoform mental disorders (average Index 8.59 vs. 7.52 points, U = 6040.5, p = 0.041). The found pattern may be useful for clinicians for screening for patients who require a multidisciplinary approach to diagnosis and treatment.

Rheumatoid arthritis associated with Rendu — Osler — Weber disease: Second description

The article presents second ever published description of rheumatoid arthritis case co-morbid with Rendu — Osler — Weber disease (hereditary hemorrhagic teleangiectasia) in a 63-yearsold female patient. The aim is describing the first case report of a patient who after a confirmed hereditary hemorrhagic teleangiectasia diagnosis developed rheumatoid arthritis one year later. Historical data and brief pathophysiological characteristic of both diseases and their possible intermingle are included: (i) mutant genes in hereditary hemorrhagic teleangiectasia all encode proteins involved in the TGF-beta signaling pathway, and increased plasma levels of TGF-beta-1 and vascular endothelial growth factor have been seen in such patients; (ii) TGF-beta plays a role in the development of synovial cell proliferation, inflammation, and angiogenesis in rheumatoid arthritis; (iii) TGF-β regulates thymic T-cell selection, inhibits cytotoxic T lymphocyte (CTL), Th1-, and Th2-cell differentiation while promoting peripheral * Contribution of L. P. Churilov was supported by the grant of the Government of Russian Federation for state support of scientific research carried out under the supervision of leading scientists, agreement 14.W03.31.0009.Treg-, Th17-, Th9-, and Tfh-cell generation, and T-cell tissue residence in response to immune challenges, all essential for pathogenesis of rheumatoid arthriitis. The defect in its reception as well as its compensatory increased blood content theoretically can alter autoimmunity thus facilitating in Rendu — Osler — Weber disease patients the development of systemic autoimmune diseases.

Neurorehabilitation: Sanogenetic and pathogenetic foundations of innovative directions

The processes of sanogenesis and pathogenesis in patients with acute cerebrovascular accident occur simultaneously, starting with the acute period of stroke. In most cases, this is a single process viewed from different perspectives. Modern innovative areas of neurorehabilitation include the use of drug therapy, rehabilitation measures and mechanisms of sanogenesis and self-healing, which can be influenced by the methods used in the course of restoring the health of neurological patients. The organizational model of modern neurorehabilitation is based on an interdisciplinary multistage approach. The analysis of the relationship between patho‑ and sanogenetic reactions is important for the development of this organizational model. Exogenous therapeutic and rehabilitation measures form a single complex with endogenous factors of sanogenesis. These measures achieve the maximum effect only with the conscious active participation of the patient in the recovery process. The theoretical basis of the research is the concept of the theory of functional systems by P. K. Anokhin and the axiomatic theory of human health. The integration of these approaches is considered as the most general self-acting self-healing mechanism, concretized in the form of the concept of sanogenesis. Mechanisms for maintaining homeostasis are activated at all levels when a damaging factor occurs. Pathogenesis develops, becoming an integral part of the processes of sanogenesis.

CT-fusion-guided thoracic endovascular aortic repair: Case report and literature review

Interventional and hybrid methods of treatment, combining open surgical and endovascular repairs, are the most promising areas in the surgery of the thoracoabdominal aorta. Recent studies, however, have demonstrated that complex thoracic endovascular aneurysm repair (TEVAR) is one of the most high-dose endovascular interventions. In addition, TEVAR is associated with the use of a significant volume of contrast media (CM), which can lead to contrast-induced acute kidney injury (CI-AKI). The use of advanced imaging techniques and computed tomographic fusion (CT-fusion) in routine practice can potentially reduce operation duration, radiation exposure and CM volume usage. We analyzed the literature on CTfusion in endovascular aortic repair and present a clinical case of a 50-year-old male with a history of concomitant blunt chest trauma. CT of the chest revealed an aneurysm of the arch and descending aorta after traumatic dissection of the aorta (IIIa DeBakey, type B Stanford), post-traumatic diaphragmatic hernia of the left dome of the diaphragm with stomach and intestinal loops prolapse. The patient underwent a staged hybrid intervention — subtotal aortic arch debranching followed by CT-fusion-guided semi-arch TEVAR. CT-fusion is a dynamically developing technology, may reduce the CM volume, the duration of the procedure and radiation exposure and requires further research.

The pathogenesis of pulmonary hypertension — vessel wall ischemia as the driving force in disease initiation and progression

Surgeons are not trained to decipher the pathogenesis of diseases, which they operate on. They are used to repair, remove, or replace defective tissues and organs. Yet, we often see typical pathomorphological or pathophysiological phenomena, characteristic of a specific disorder that can only be observed during surgery. Such patterns would not be recognized easily by current imaging techniques, and their visibility would require a living organism. In modern terminology, one could call them “surgical biomarkers”. Many disease entities, today, are still not completely deciphered regarding initial links of their pathogenesis, despite decades of experimental and clinical research. In such disorders, characteristically named “idiopathic”, surgical observations may be helpful to clarify disease mechanisms, two of which we offer here for one of these disease entities, namely pulmonary hypertension.